Evidence map›Paper›PMID 41123610›Full record

ReviewEuropean spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society2026

Predictive value of deformity angular ratio (DAR) for intraoperative neuromonitoring (IONM) signal loss and neurological complications in spinal deformity surgery: a systematic review and meta-analysis.

Sadegh Bagherzadeh, Morteza Sadeh, Saman Shabani, Schahin Salmanian, Dana Saleh, Diego Soto Rubio, Patrick Kim, Puya Alikhani, Mohsen Rostami

Abstract readReview
PubMed Publisher
In one paragraph

Review in European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.

0numbers the graph read from it
0cells of the map it votes in
1citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

1 citing paper in PubMed.

  1. Review
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

9 authors.

Sadegh BagherzadehDepartment of Neurosurgery, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran.ORCID http://orcid.org/0009-0000-1545-9218
Morteza SadehDepartment of Neurosurgery, University of Illinois at Chicago, Chicago, USA.
Saman ShabaniDepartment of Neurosurgery, Medical College of Wisconsin, Milwaukee, USA.
Schahin SalmanianDepartment of Neurosurgery, Brain and Spine, University of South Florida, Tampa, USA.
Dana SalehDepartment of Neurosurgery, Brain and Spine, University of South Florida, Tampa, USA.
Diego Soto RubioDepartment of Neurosurgery, Brain and Spine, University of South Florida, Tampa, USA.
Patrick KimDepartment of Neurosurgery, Brain and Spine, University of South Florida, Tampa, USA.
Puya AlikhaniDepartment of Neurosurgery, Brain and Spine, University of South Florida, Tampa, USA.
Mohsen RostamiDepartment of Neurosurgery, Brain and Spine, University of South Florida, Tampa, USA. mohsenrostami@usf.edu.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

purposeSpinal deformity surgery carries a high risk of intraoperative neuromonitoring (IONM) signal loss and neurological complications. The Cobb angle has traditionally been used to assess spinal deformity severity, but the Deformity Angular Ratio (DAR) has been proposed as a potentially more precise predictor of surgical risks. This systematic review and meta-analysis aimed to compare the preoperative DAR to the Cobb angle to predict the loss of IONM signal and the presence of postoperative neurological complications in spinal deformity correction.

methodsA systematic literature search followed PRISMA guidelines across PubMed, Scopus, Embase, and Web of Science from their inception to August 2024. Studies were included if they reported Cobb angles, DAR values, IONM signal loss, and/or neurological complications in spinal deformity patients. The Newcastle-Ottawa Scale (NOS) was used for quality assessment. Random-effects meta-analysis was performed to assess the association between Cobb angles, DAR, IONM signal loss, and neurological complications, with Trim and Fill correction applied to adjust for publication bias.

resultsSeven high-quality retrospective cohort studies (1,074 patients) were included. Sagittal Cobb (S-Cobb), Coronal Cobb (C-Cobb), and Total Cobb (T-Cobb) angles were significantly associated with IONM signal loss. Sagittal DAR (S-DAR > 12°) and Total DAR (T-DAR > 22°) were strongly correlated with IONM signal loss, while Coronal DAR (C-DAR) showed no significant association after publication bias correction. T-DAR greater than 39° was the only parameter significantly associated with postoperative neurological complications.

conclusionsDAR demonstrates greater predictive value than the Cobb angle for identifying patients at high risk for IONM signal loss, with T-DAR showing the strongest correlation. The greater impact of sagittal imbalance (S-DAR, S-Cobb) on IONM signal loss is likely due to spinal cord vascular and mechanical factors.

Indexed as

Deformity angular ratioIntraoperative neuromonitoring (IONM)Neurological complicationsSpinal deformity surgery

Identifiers

PMID41123610

What OpenQuestion holds

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.